Living Yellow

My long, enjoyable break from chemo came to an abrupt conclusion this week and I jumped back in to the deep end of the chemo pool. I was prepared to get going again and, other than some pain issues, was feeling alright about it. In fact, I put on a few pounds of “cushion” to help stave off the initial weight loss. As it turned out, however, over my last weekend of freedom, I jaundiced – and that has made it quite a bit less pleasant. Doctor S had always warned about the possibility of jaundice and I guess we really did push this thing as far as we could. But, as a result, I was in and out of the hospital from Friday until Wednesday, which has been a strain on everyone. I’m also not out of the woods yet, but with some luck, it will clear and I will just get back to my old chemo regiment.


I did learn a few things about jaundice during all the doctor consultations. Here’s a quick lowdown on what it’s all about. Jaundice is the yellowing of the eyes and skin caused by an increase in the level of bilirubin in your blood. Simply put, when the bile ducts in your liver get clogged and the bile can’t flow, your blood bilirubin elevates and you turn yellow. In my case, the bile duct clog(s) is being caused by the tumor(s) pressing against the ducts. The biggest danger of jaundice is the risk of infection in the liver and blood.

The three options we discussed with the doctors this week to alleviate the problem were a) an endoscopy – where a scope is put down your throat to the base of the liver and a stent put in to open up the bottom of the bile duct, if that’s where the clog is b) a more invasive technique where a needle is put in through your side and a drain inserted to siphon off bile externally, if the blockage is high up in the liver or c) chemotherapy to reduce the tumor size and relieve the pressure. In my case, the blockage(s) appear to be high up in the liver, but their placement, relative to the location of the tumors made it “technically difficult” to insert a drain. The endoscopy docs were willing to try to reach it from the bottom but said upfront that it would be “technically difficult” to reach up the ducts that far with their instruments. Thus, my treatment course is to immediately get chemo and hope that some quick shrinkage of the tumor(s) will open up the ducts.

In the meantime, I need to be very careful about getting an infection – although I am not entirely sure what I can do about that except to stay away from public places. The combination of chemo and jaundice really saps all my energy anyway, so it’s not that big of a sacrifice.

So at the end of the day, I actually did start chemo, as originally planned, on Tuesday. The only change is that I was going to switch to a new drug – Irinotecan – rather than the Oxaliplatin I started with last time. Irinotecan cannot be given to a person with jaundice. So, Oxi it is and I have immediately felt its major side effect – extreme cold sensitivity. As I get more and more of it in the coming months, I will lose feeling in my fingers and toes, just like last time. But – if we can shrink the tumors and I regain a human hue, it’ll be well worth it.

As an aside, to gauge my progress, David and I have been analyzing my color using the Martha Stewart color chart we had left over from painting the den last year. I am a rather attractive shade now, somewhere in the neighborhood of “Ginger Root” and “Tahini.” Somehow I doubt it would sell if she had one called “Jaundice!”